Healthcare Provider Details

I. General information

NPI: 1124659180
Provider Name (Legal Business Name): ELDON FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N BUSINESS HIGHWAY 54 E STE D
ELDON MO
65026-2041
US

IV. Provider business mailing address

PO BOX 8
HIGH POINT MO
65042-0008
US

V. Phone/Fax

Practice location:
  • Phone: 573-286-2638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN RENE PORTER
Title or Position: OWNER/PHYSICIAN
Credential: DC
Phone: 573-286-2638